Abstract

Objectives: This study aimed to understand the
experiences and expectations of people seeking
bariatric surgery in England and identify implications
for behavioural and self-management interventions.
Design: A qualitative study using modified photovoice
methods, triangulating photography with
semistructured indepth interviews analysed using
framework techniques.
Setting: Areas served by two bariatric surgery
multidisciplinary teams in the north of England.
Participants: 18 adults (14 women and 4 men) who
accepted for bariatric surgery, and were aged between
30 and 61 years. Participants were recruited through
hospital-based tier 4 bariatric surgery multidisciplinary
teams.
Results: The experiences of participants indicates the
nature and extent of the burden of obesity. Problems
included stigmatisation, shame, poor health, physical
function and reliance on medications. Participants
expected surgery to result in major physical and
psychological improvement. They described how this
expectation was rooted in their experiences of stigma
and shame. These feelings were reinforced by previous
unsuccessful weight loss attempts. Participants
expected extreme and sometimes unrealistic levels of
sustained weight loss, as well as improvements to
physical and mental health. The overall desire and
expectation of bariatric surgery was of ‘normality’.
Participants had received previous support from
clinicians and in weight management services.
However, they reported that their expectations of
surgery had not been reviewed by services, and
expectations appeared to be unrealistic. Likewise, their
experience of stigmatisation had not been addressed.
Conclusions: The unrealistic expectations identified
here may negatively affect postoperative outcomes. The
findings indicate the importance of services addressing
feelings of shame and stigmatisation, and modifying
patient’s expectations and goals for the postoperative
period.